Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY

We are seeking an experienced Medical Economics Analyst to join our healthcare analytics team. This role will focus on analyzing healthcare cost trends, evaluating medical cost reduction program effectiveness, and providing data-driven insights to support strategic decision-making in value-based care initiatives.

JOB SPECIFICATIONS

  • Lead complex analyses of medical cost trends, utilization patterns, and medical cost savings program effectiveness.
  • Design and execute measurement strategies for medical cost affordability initiatives.
  • Evaluate financial and clinical outcomes of value-based contracting arrangements.
  • Develop forecasting models to project future medical costs and program savings.
  • Create and maintain dashboards to track key performance indicators.
  • Partner with clinical and business teams to identify opportunities for medical cost reduction or optimization.
  • Present findings and recommendations to senior leadership.
  • Influence strategic decisions affecting medical cost management.
  • Drive millions in potential savings through program evaluation.
  • Support network optimization and value-based contracting.
  • Contribute to annual budgeting and forecasting processes.
  • Collaborate across departments including Finance, Clinical, and Operations.


QUALIFICATIONS:

  • Education/Specialized Training/Licensure: Bachelors degree in mathematics, Economics, Statistics, Engineering, or related field required.
  • Work Experience (Years and Area): 8 years of experience as a systems analyst, business analyst, in medical economics, or other related analytics function required.
  • 5 years of professional experience in a healthcare organization required.
  • Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other:

  • Strong understanding of healthcare payment models and medical cost drivers.
  • Experience with claims data analysis and risk adjustment methodologies
  • Expertise in statistical analysis and research design
  • Demonstrated Ability to translate complex analyses into actionable insights
  • Strong analytical and problem-solving abilities.
  • Excellent project management skills.
  • Clear written and verbal communication.
  • Ability to work independently and in teams.
  • Detail-oriented with strong quality control focus.
  • Strategic thinking and business acumen.
  • Experience with value-based program evaluation.
  • Background or experience with actuarial analysis.
  • Strong understanding of healthcare payment models and medical cost drivers.
  • Experience with claims data analysis and risk adjustment methodologies
  • Expertise in statistical analysis and research design
  • Demonstrated Ability to translate complex analyses into actionable insights
  • Strong analytical and problem-solving abilities.
  • Excellent project management skills.
  • Clear written and verbal communication.
  • Ability to work independently and in teams.
  • Detail-oriented with strong quality control focus.
  • Strategic thinking and business acumen.

Reports to Position Title: Actuarial Director

COMPETENCIES

  • Analytical Thinking
  • Motivated
  • Results Oriented
  • Taking Initiative

Application Instructions

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